recovery, nursing,

consumers’ experiences

Research into Recovery Network

IOP, KCL November 2013

Dr Bridget Hamilton

University of Melbourne

3 practice evaluations: consumer views of case management with the

Strengths Model in sesidential & MST teams in 2011

WRAP/daily maintenance plan in acute psychiatric unit of St Vincent’s in 2013

evaluation of the Nursing and Midwifery Health Program in Victoria in 2012

practice

experience

recovery

recovery?

…as defined in Australian Policy:

A deeply personal, unique process of changing

one’s attitudes, values, feelings, goals, skills

and/or roles. It is a way of living a satisfying,

hopeful and contributing life. Recovery involves

the development of new meaning and purpose in

one’s life as one grows beyond the catastrophic

effects of psychiatric disability.

…from the Glossary in National Standards for Mental Health Services (2010),

p39

recovery elements: Leamy et al 2011

Connectedness

Hope, optimism

Identity

Meaning, purpose

Empower-

ment

recovery-oriented (nursing) practice?

philosophy & intention

practices …as judged by whom?

experiences of being assisted/supported

towards recovery

defining Recovery Oriented Practice as whatever

practitioners do that might add to people’s

experiences of CHIME

recovery-oriented (nursing) practice?

= whatever might add to people’s experiences of CHIME

Formal/published approaches & tools:

Tidal model

Wellness Recovery Action Planning = WRAP

Strengths approach to assessment & goal planning

Safewards interventions?

REFOCUS?

Peer support – active linkage with

…your other ideas?

practice

experience

recovery

recovery oriented practice?

experience

of services

practices

of CMs

experiences of nursing (1)

Valued relationship characteristics: when we are warm, genuine, able to listen, optimistic, respectful

Every participant spoke of this

Evan:…what is it like to have a case manager?

Andrew: Well you know I think it’s a good thing to have somebody who’s, you know, able to listen to you and respect your needs. (p79)

Tom: She’s become like a genuine friend, …whatever my issues are at the time, whether they be personal or whatever, she doesn’t judge and stuff, which is important. (p125)

experiences of nursing (2)

Valued roles: when we are accessible, contactable, practically helpful

Most participants valued this the most

Evan:…what is it like to have a case manager?...

Elizabeth: Oh its wonderful, somebody to lean on, to tell your troubles to, somebody that cares for you, and somebody that does a good job in helping you out. (p96)

Marcus:…they have helped me get my life back on track in a way, like I had parking fines, and they helped (p47)

experiences of nursing (3)

Skills to push, to coach or to motivate

7/20 consumers talked about this, what was helpful & not

so helpful

Ingrid: She wouldn’t press it, you know, she’d give me the

opportunity to decide for myself whether it was actually something

I wanted to do (like quitting smoking dope) (p35)

Tina: I have to say though in terms of the Strengths Model, and

that’s what my second case manager’s doing, I didn’t think I could

be able to handle it, nor would I want to at the beginning. …If I

had someone almost I felt was pushing me at a time where I

couldn’t be pushed (p69)

experiences of nursing (4) Skills to push, coach or motivate

Yan: He’s given me a boost.

Evan: how has he done that?

Yan: Just nice compliments & stuff, yeah.

Cathy: What would make him better than other ones (case managers)?

Yan: He just goes around things better. He’s good at motivation & stuff.

Cathy: So how does he motivate you?

Just compliments & stuff. Yeah, sort of a bit of pushing as well, which is good.

experiences of nursing (5)

Experiences of practice impeding recovery

Evan: What is it like to have a case manager?...

Amon: Terrible. …Terrible to have people apart from those who have your interests at heart deciding things about you (p87)

Evan: how could she improve?

Tom: she was more like for the medication. She was stressing more on the medication and less on the self-improving and looking on the positive side of things (p107)

is this recovery oriented?

fidelity with Strength Model

overall strong results

pushing can be goal striving …or

something else

clinical focus pose challenges

coercive flavour is low point

CHIME–ing quite nicely in parts

recovery oriented practice?

experiences

of acute services

practice in acute wards

Strengths Model: fidelity measurement

practices in acute services Aims

identify features of recovery oriented practice in patient records

assess fidelity of documentation with Strengths Model

Method

qualitative & quantitative audit of WRAP & other documents

fidelity with “hope inducing language” (as per Appendix 2, R&G

2012)

Fidelity Scale, Item 11

“Case managers exhibit hope inducing behaviours when interacting

with people receiving services or other staff”

details of hope inducing behaviours

(appendix II)

building hope

treating people with respect

focusing on the positive

celebrating success

close assistance, advocacy

working towards goals

promote choice

education

future beyond the treatment system

St.Vincent’s Acute Inpatient Services

fidelity audit tool – 7/20

story in a patient file on day 14 157 pages (single & double side)

bulky with standard forms, registrations, legal tests & results

recovery related forms were all blank

checklists: FEP, admission, discharge

1/5 is progress notes, mainly nurses & doctors writing

tone is cautious, measured

PBs wishes in verbatim phrases

bundle of risk assessments at the very back

is this recovery oriented? No

traces to be found

burden of de-personalised activity, bio-workup

alliance through FEP psycho-education, navigating the

system, a single goal to exit

respectful standoff - is this intrinsic to involuntary

admission?

recovery oriented practice?

nurses experience

as service users

nursingpractice

with nurses

nurses / consumers

NMHP, for nurses with mental health or substance use

problems

alternative-to-discipline model

evaluation commissioned at 6 years of operation

mixed methods outcome evaluation

mapped Program Logic

routine case-based data, health promotion data

anonymous feedback surveys (N=125)

focus groups with clients, employers & regulators

activity, health & work outcomes, experiences

evaluation findings Referral

self (75%), employers/colleagues (16%), regulator (9%)

Service

individual & group support (647 nurses)

case management (31% nurses)

Outcome

work (79% of case-managed nurses)

experience: Relationship, understanding & practical assistance

I found the program invaluable, as I didn’t feel ashamed, embarrassed or degraded when I was at my lowest and extremely vulnerable. …my professionalism and inner strength were maintained, knowing that I wasn’t the only nurse in this situation

value of peers for hope, connection,

identity, empowering

Without this group I don’t think I could be so successful in my recovery

How helpful it was to to speak with another nurse who knows this industry and how challenging it can be at times

At one meeting someone brought up having no structure in their life and I realised I didn’t either. …I am starting to get some structure back in my life

practice

experience

recovery

as work

as wellbeing

References

Bettinardi-Angres, K., Pickett, J., & Patrick, D. (2012). Substance Use Disorders and Accessing Alternative-to-Discipline Programs. Journal of Nursing Regulation, 3(2), 16-23

DoH Victoria (2011). Framework for Recovery Oriented Practice. Accessed at :www.health.vic.gov.au/mental health

Hamilton, B., Bichara, E., Roper, C., & Easton, C. (2012). Gaining Strength: Consumers’ experiences of case management with the Strengths Model. Melbourne: St Vincent's Health, Victorian Department of Health.

Hamilton, B. and R. Duncan (2012). Evaluation of the Nursing & Midwifery Health Program: Final Report. Melbourne, Victoria, University of Melbourne: i-xiii, 1-59.

Higgins, A., Callaghan, P., deVries, J., Keogh, B., Morrissey, J., Nash, M., . . . Carter, T. (2012). Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: A mixed methods pre-postevaluation. Journal of Advanced Nursing, 68(11), 2418-2428.

Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. (2011). A conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry. 199, 445-52.

Scott, A., & Wilson, L. (2011). Valued identities and deficit identities: Wellness Recovery Action Planning and self-management in mental health. Nursing Inquiry, 18(1), 40-49.

Smith-Merry, J., Freeman, R., & Sturdy, S. (2011). Implementing recovery: an analysis of the key technologies in Scotland. International Journal of Mental Health Systems, 5(1), 11.